Thread by @Jonathan_Witt

This thread is by no means comprehensive with regards to the #NHIBill but here goes.

Nationalised healthcare, otherwise known as universal healthcare, is generally bound by something called the ‘Iron Triangle’. It states that with regards to healthcare systems you can have any 2 of the following:

- Access
- Quality
- Cost effectiveness

Never all 3.

The reason for this is simple economics which acknowledges that hospitals and doctors are finite resources, and the field of healthcare an ever expanding list of treatement options and procedures. With enough money it is possible to ‘break’ the Iron Triangle but only temporarily.

Suffice to say that South Africa neither has the funding nor the resources to break the triangle. In fact the #NHI arguably provides only 1 of the 3 imperatives - access. It will not be able to provide uniform quality and it will be highly cost ineffective for actual taxpayers.

Regarding the specifics announced today the biggest problems thus far seem to be changes to:

- Medical Aid administration
- Brokers
- Co-payments

And of course the funding “model” (that’s a generous description) is both unrealistic and contemptuous.

The Government essentially wants to take over the role of all medical aids. They intend to treat every citizen as a member of a centralized medical aid. Think Home Affairs but for Health, then repeat that statement and you’ll understand the problem.

At the same time as stating that the NHI will provide healthcare for everyone the Government also envisions continued existence of medical aids, but if the NHI will be as wonderful as claimed then nobody would need further cover. It’s either an admission or a slip of the mask.

In addition Government seems to have a problem with the 25% liquidity held by medical schemes, however this is regulated by legislation and is not the choice of anyone actually running a medical aid. It’s like being angry with the way you dressed yourself today.

The removal of brokers saves less than R100 per month on each policy but it also removes an individual who advises people on the best medical plan for their purposes and life stage. Taking away this information provider isn’t a train smash but does seem short sighted.

Lastly the proposed abolishing of co-payments isn’t the great coup some seem to think. Medical aids charge co-payments because some procedures are too costly to be subsidized by the scheme. Thus part of a procedure is paid for instead of none of it.

Doctors too sometimes charge co-payments usually to supplement the fee paid to them by the medical aid which undervalues their skill or time. Removing these payments will only result in a decreased supply of doctors to perform certain procedures.

Over and above this the entire system is being set up to be hostile to medical professionals and their freedom. The entire world needs doctors, and we still train some of the best in the world. Government sticking their proverbial finger in doctors’ eyes is highly ill advised.

Government has proven again & again that they are not capable of running even the most basic of entities. It just doesn’t get more complex than healthcare. In reality this appears to be more of a cash grab than anything else - you’ll now pay tax, NHI, and if you can medical aid.

The long term effects are obvious. This will bring more people down to a lower level of care as opposed to raising them up to a higher level. There are many possible solutions to making healthcare better and more accessible, but NHI simply is not one of them.